Study: Minor Injuries in Some Children May Indicate the Possibility of More Serious Child Abuse Later On
A study in Pediatrics finds that relatively minor abuse injuries often precede more serious abuse of children. The study refers to “sentinel” injuries—a previous injury reported in a child’s medical history that was suspicious or had an implausible explanation. Researchers examined records of infants seen by the child protection team at Children’s Hospital of Wisconsin between March 2001 and October 2011. Of the 200 children who were definitely abused, 55 (27 percent) had a sentinel injury. Of those, 80 percent had a bruise, 11 percent had an injury inside the mouth, and 7 percent had a fracture. Of 100 children where abuse was suspected but not confirmed, 8 had a sentinel injury. None of the infants in the control group—who had no history of abusive injuries—had a sentinel injury. The study authors say their findings suggest that in more than a quarter of cases of definite physical abuse, there may be escalating and repeated violence toward the infant instead of a single event of momentary loss of control by a frustrated or angry caregiver. Improved recognition of sentinel injuries and interventions would prevent additional cases of child abuse, according to the researchers. Read more on injury prevention.

HUD Renews Grants for Local Communities’ Response to Homelessness
The U.S. Housing and Urban Development Department (HUD) is renewing funding for 7,000 local homeless housing and service programs across the country. The funding ensures the programs will remain open for at least the coming year, according to HUD, which has challenged local communities to review their response to homelessness and to emphasize proven strategies including “rapid re-housing” for homeless families and permanent supportive housing for people who experience chronic homelessness. The amount of renewed funding is $1.5 billion in grants that will support programs including street outreach, client assessment and direct housing assistance. HUD expects to award additional grants later this year. HUD recently announced its 2012 “point in time” estimate of the number of homeless persons in America. Approximately 3,000 cities and counties reported 633,782 homeless persons on a single night in January of 2012. Read more on housing.

Policy and Practice Changes Needed to Improve Survival in People who have Heart Attacks in the Hospital
Policy and practice changes by healthcare institutions, providers and others could greatly improve survival for people who have a have a heart attack in the hospital, according to an American Heart Association (AHA) consensus statement in its journal, Circulation. Each year, more than 200,000 adults and 6,000 children have in-hospital cardiac arrests, and survival has remained essentially unchanged for decades, according to the AHA. Only 24.2 percent of in-hospital cardiac arrest patients survive to hospital discharge.

Key recommendations include:

• Establishing competency of all hospital staff in recognizing a cardiac arrest, performing chest compressions and using an automated external defibrillator or AED.
• Ensuring that best practices are used in all stages of care for cardiac arrest.
• Requiring that all in-hospital cardiac arrests be reported, with survival data, using consistent definitions across hospitals. Definitions currently are not standardized, according to the researchers.
• Modifying billing codes to allow collection of more specific and accurate data for in-hospital cardiac arrest.
• Separate guidelines for in-hospital versus out-of-hospital cardiac arrests.

Read more on heart health.

Judge Strikes Down N.Y. City’s Sugary Drink Limit; Bloomberg to Appeal
“The loopholes in this rule effectively defeat the stated purpose of this rule,” wrote State Supreme Court Justice Milton Tingling when striking down New York City’s 16-ounce limit on sodas and other sugary drinks just hours before it was set to go into effect. He also called the law “arbitrary and capricious.” Still, Mayor Michael Bloomberg says he expects to win on appeal. “As far as we have come, there is one public health crisis that has grown worse and worse over the years, and that is obesity," he said at a news confernce. "Five thousand people will die of obesity this year in New York. The best science tells us that sugary drinks are a cause of obesity." Read more on obesity.

NFL, GE Partner in $60M Effort to Study and Prevent Brain Injuries
The National Football League and General Electric Co have announced a $60 million partnership to advance research into brain injuries while also developing new technologies to help limit injuries to athletes. It includes $40 million for research into imaging technologies and $20 million for researchers and businesses working on injury prevention, identification and management. The NFL has faced multiple lawsuits related to concussions, including a class action on behalf of 4,000 former players. "We're trying to do this with the best minds anywhere in the world," said GE Chairman and CEO Jeff Immelt at a news conference. Each year, U.S. emergency rooms see about 173,000 temporary brain injuries related to sports and recreation in people age 19 and under, according to the U.S. Centers for Disease Control and Prevention. Read more on injury prevention.

Ovarian Cancer Patients Who Don’t Receive Recommended Treatment More Likely to Die in 5 Years
Ovarian cancer patients who do not received the treatment recommended by the National Comprehensive Cancer Network (NCCN) clinical practice guidelines—or as many as two-thirds of patients—have a 30 percent greater risk of dying within five years, according to new findings to be presented at the annual meeting of the Society of Gynecologic Oncology. The study found that low-volume hospitals that treat fewer ovarian cancer patients are less likely to follow the treatment guidelines. "The high-volume hospitals, which did 20 or more cases a year, and high-volume physicians, which did 10 or more a year, were significantly more likely to administer treatment that was adherent to NCCN guidelines," said Robert Bristow, MD, director of gynecologic oncology at the School of Medicine of the University of California, Irvine. According to the American Cancer Society, in the United States, approximately 22,000 new cases of ovarian cancer are diagnosed each year and 15,000 women die from the disease. Read more on cancer.

Obese Drivers at Greater Risk of Dying in a Car Crash
Obese drivers are up to 78 percent more likely to die in a car crash than normal-weight drivers, according to a recent study by researchers at the UC Berkeley’s Safe Transportation and Research Education Center. Researchers reviewed data on accidents recorded in the managed by the National Highway Traffic Safety Administration’s Fatality Analysis Reporting System, and found that drivers with a Body Mass Index (BMI) in the obesity range (over 30) were more likely than other drivers to die in a car crash even if they were wearing a seat belt and an airbag deployed. The researchers say that other health problems the obese drivers had could have been a factor in their deaths, but say that cars may not be designed people who are overweight. The study was published in the Emergency Medicine Journal. Read more on injury prevention.

AHRQ Releases Patient Safety Strategies
The Agency for Healthcare Research and Quality recently released 10 patient safety strategies for hospital and other health care facilities that the agency says can save lives:

• Preoperative checklists and anesthesia checklists to prevent operative and postoperative events
• Checklists to prevent central line-associated bloodstream infections
• Interventions to reduce urinary catheter use, including catheter reminders, stop orders, or nurse-initiated removal protocols
• Interventions including head-of-bed elevation, to prevent ventilator-associated pneumonia
• Hand hygiene
• The do-not-use list for hazardous abbreviations
• Interventions to reduce pressure ulcers
• Barrier precautions to prevent healthcare-associated infections
• Use of real-time ultrasonography for central line placement
• Interventions to improve prevention of blood clots

Read more on safety.

Study Finds Soccer Programs Increase Exercise among Low-Income Kids
A study by researchers at the University of California, Berkeley School of Public Health finds that an after-school soccer program and literacy program has been successful in increasing physical activity among elementary school children. The researchers found that the program increased moderate-to-vigorous physical activity by an average of 3.4 minutes per weekday and 18.5 minutes on Saturdays among students with a body mass index at or above the 85th percentile, when compared with students at control schools who did not host the program. The program did not significantly increase physical activity among children who were not overweight or obese. Read more on obesity.

Better Nutrition Advice Comes From Doctors Who Cook
At the “Healthy Kitchens, Healthy Lives – Caring for our Patients and Ourselves” conference presented by Harvard University and the Culinary Institute of America, health care professionals have been learning about both nutritional science and how to cook. The program was influenced by the idea that healthcare professionals practicing healthful behaviors—such as healthy eating, exercising, or wearing a seat belt—may be more likely to pass these same behaviors onto their patients.

A 2010 survey of 219 conference participants before the conference and 192 participants three months after found:

• 58 percent of healthcare professionals cooked their meals before the conference; 64% afterwards with reports of eating more whole grains, nuts and vegetables
• 46 percent said they could successfully advise an overweight patient on nutrition and lifestyle before the conference; 81% said they could afterwards

The researchers believe they “need enhanced educational efforts aimed at translating decades of nutrition science into practical strategies whereby healthy, affordable, easily prepared and delicious foods become the predominant elements of a person’s dietary lifestyle.” Read more on nutrition.

Caffeine During Pregnancy Linked to Smaller, Later Newborns
Coffee and other caffeinated beverages consumed during pregnancy might increase the odds for low birth weight or an extended pregnancy, according to a new study in BMC Medicine. The study looked at about 60,000 pregnancies tracked by the Norwegian Institute of Public Health. Researchers found that caffeine from all sources was tied to a higher risk for reduced birth weight and that every 100 mg of caffeine consumed per day extended pregnancy by five hours. Caffeine from coffee extended pregnancy by eight hours. The World Health Organization advises women to limit their caffeine consumption to 300 mg a day during pregnancy, while the United States recommends a 200 mg daily limit. Read more on maternal and infant health.

CDC: Reductions in Some Types of Health Care-Associated Infections
Progress in the fight against certain bloodstream and surgical-site infections continues in hospitals in the United States, according to a U.S. Centers for Disease Control and Prevention (CDC) report. The report looked at data submitted to the National Healthcare Safety Network (NHSN), CDC’s infection tracking system. CDC reported a 41 percent reduction in central line-associated bloodstream infections since 2008 and a 17 percent reduction in surgical site infections since 2008. “The significant decrease in central line and surgical site infections means that thousands of patients avoid prolonged hospitalizations and the risk of dying in the hospital,” said Patrick Conway, chief medical officer of the Center for Medicare & Medicaid Services (CMS). The data indicates hospitals are making progress toward the goals established in 2008: 50 percent cut in central line-associated bloodstream infections and a 25 percent cut in surgical site infections in five years. Read more on injury prevention.

U.S. Preventive Services Task Force Recommends Physicians Ask All Women about Intimate Partner Violence
Physicians should screen all women of childbearing age for signs of domestic violence and refer them for treatment if necessary, according to a new recommendation from the U.S. Preventive Services Task Force. In the United States, according to the U.S. Centers for Disease Control and Prevention, nearly one-third of women and more than 25 percent of men have been victims of domestic violence. In addition to the risks of injury and death, people who experience domestic violence may also develop sexually transmitted diseases, pelvic inflammatory disease, unintended pregnancies, chronic pain, neurological disorders, gastrointestinal disorders, depression, anxiety, post-traumatic stress disorder, substance abuse and suicidal behavior. Domestic violence in women is also linked to preterm birth and low-birth weight babies. The panel found that women who were screened for domestic violence were far more likely to discuss the issue with their doctor than women who were not screened. Read more on violence.

AAP: Playgrounds Need Yearly Safety and Quality Check
A new study of close to 500 Chicago playgrounds published in Pediatrics finds that the quality and safety of playgrounds can vary by neighborhood. Researchers looked at the playgrounds between 2009 and 2011 and assessed four categories: age-appropriate design, ground surfacing, equipment maintenance and physical environment. While most of the playgrounds met the criteria for age-appropriate design and physical environment, failing grades were often given for problems with ground surfacing, such as not enough wood chips to cushion falls, or equipment maintenance problems. The authors also found that neighborhoods with a higher percentage of low-income individuals had both fewer overall sites and more failing-grade playgrounds. The researchers reported failing grades to local authorities, which led to more passing grades at the end of the study. The researchers say strengthening community partnerships and training appropriate staff for yearly playground checks can result in a safer urban play environment for children. Read more on pediatrics.

Tenth Annual Traffic Law Report Card Finds Fewer Laws and More Deaths
The tenth annual report card on traffic safety by the group Advocates for Highway and Auto Safety finds that several states have repealed traffic safety laws and others have not moved to enact new ones. Last year only 10 state highway safety laws were enacted, while 16 laws were passed in 2011 and 22 were passed in 2010. According to the group, preliminary National Highway Traffic Safety Administration (NHTSA) data show the largest jump in traffic fatalities since 1975, a 7.1 percent increase in crash deaths during the first nine months of 2012 compared to the first nine months of 2011. The report card also found that:

• 18 states still need a primary enforcement seat belt law;
• 31 states still need an all-rider motorcycle helmet law;
• 19 states still need an booster seat law;
• No state meets all the criteria of Advocates’ recommended Graduated Driver’s License program;
• 40 states and Washington, D.C. are missing one or more critical impaired driving laws and;
• 15 states still need an all-driver text messaging restriction.

Read more on injury prevention.

Public Health Law Research (PHLR), a program of the Robert Wood Johnson Foundation, will hold its annual meeting in New Orleans this week. NewPublicHealth will be on the ground covering sessions on research in public health law as well as posting interviews with conference speakers including Thomas Farley, MD, MPH, Health Commissioner of New York City and Pamela Hyde, JD, administrator of the federal Substance Abuse and Mental Health Services Administration.

In advance of the conference, NewPublicHealth spoke with Diana Silver, PhD, MPH, assistant professor of public health at the Steinhardt School of Culture, Education and Human Development at New York University. Silver’s research looks at the impact of public and private services on health and well-being for children and families, especially in urban America. Her presentation at the PHLR annual meeting is called “Are More Laws Better?” with a specific  look at what has happened to traffic fatalities between 1980 and 2009 as new laws have been implemented in some parts of the country.

NewPublicHealth: Tell us about your research on laws and traffic fatalities.

Diana Silver: The motivating idea here was that there are multiple laws at the state level that govern traffic safety. Some deal with alcohol, some deal with restraining children one way or another in the car, some are about the vehicle itself such as seatbelts or speed limits. The laws vary at the state level, and they create, in some sense, really different environments that people are exposed to. We have now categorized across 30 years 25 different laws in all 50 states. 

What we found is that there are some laws that virtually all states have adopted, mostly because there’s been a federal mandate to do so, like a minimum legal drinking age. But many laws vary across states, and so we were interested to find out what factors predicted whether a state would pick up new laws and how quickly they would do that. Then, how do these different packages predict, or are they associated with reductions in motor vehicle fatalities?

NPH: How was your research different than other research that looks at this data?

The NewPublicHealth National Prevention Strategy series is underway, including interviews with Cabinet Secretaries and their National Prevention Council designees, exploring the impact of jobs, transportation and more on health. “Stable Jobs = Healthier Lives” tells a visual story on the role of employment in the health of our communities.

Some highlights:

• Since 1977, the life expectancy of male workers retiring at age 65 has risen 6 years in the top half of the income distribution, but only 1.3 years in the bottom half.
• 12.3 million Americans were unemployed as of October 2012.
• Laid-off workers are 54% more likely to have fair or poor health, and 83% more likely to develop a stress-releated health condition.
• There are nearly 3 million nonfatal workplace injuries each year.
• The United States is one of the few developed nations without universal paid sick days.

Also check out our previous infographics exploring the connection between transportation and health, and education and health.

>>For more on employment and health, read a related issue brief.

View the full infographic below.

Survey: 34 Percent of Smokers Trying to Quit in 2013
About 34 percent of American smokers have selected quitting as one of their 2013 New Year’s resolutions, up from 18 percent last year, according to a new study conducted on behalf of Legacy. Health factors and the cost of cigarettes were both cited as reasons. It takes an average of six to nine attempts for people to successfully give up smoking, making this period especially important to support those giving it a try. “Many smokers may have begun their New Year’s quit attempt and have already relapsed and that’s okay,” said Cheryl G. Healton, DrPH, President and CEO of Legacy. “We need to encourage them to build a quit plan and then try to quit again.” Read more on tobacco.

ASCO Outlines Recommendations on Care for Cancer Survivors
The American Society of Clinical Oncology (ASCO) has released new recommendations on how to improve the quality of care cancer survivors, who are at risk for other health problems and issues stemming from treatment. About 13 million cancer survivors are in the country. The recommendations help health care providers, patients, researchers and policymakers prioritize the components of care. "Most patients still want to see their oncologists even after they have finished active treatment,” said Sandra Swain, MD, FACP, ASCO president. “Oncologists are well positioned to lead and develop a strategy for coordinating follow-up care with primary care providers." They were published in the Journal of Clinical Oncology.  Read more on cancer.

IOM to Study Sports-related Concussions for Youth Athletes
The Institute of Medicine, part of the National Academies of Science, has launched a new national study on sports-related concussions for youth athletes. The panel plans to submit its report this summer for publication in late 2013. U.S. emergency rooms report about 173,000 sports-related temporary brain injuries—including concussions—each year, according to a 2010 study by the U.S. Centers for Disease Control and Prevention. Concussions have been linked to increase risk of mental illness, including depression, and can even lead to suicide. Read more on injury prevention.

Health Highlights of 2012
On this last day of the year, the news site HealthDay ticks off some significant health events of the last twelve months:

• The June Supreme Court ruling upholding most of the Affordable Care Act.
• The outbreak of deadly fungal meningitis linked to tainted steroid injections that began during the summer. As of December 17, the outbreak had infected 620 people and killed 39 people across 19 states. On Dec. 20, health officials from all fifty states met with U.S. Food and Drug Administration representatives to discuss proposed regulation to help prevent such events in the future.
• Autism incidence keeps rising. In March, the Centers for Disease Control and Prevention estimated the prevalence of the disorder at one in every 88 children, up from one in 110 in 2010. Cases were also five times more common in boys than girls, the agency found. While changes in how autism is spotted and reported may have played a role in the new numbers, other factors behind the increase are unclear.
• This year saw two major milestones in HIV testing and treatment. In July, the FDA approved OraQuick, the first at-home HIV test, which enables people to privately assess their infection status within 20 minutes. The same month the FDA approved Truvada, the first HIV drug aimed at preventing transmission of the virus to uninfected people who are at high risk.
• Two new diet drugs were approved by the U.S. Food and Drug Administration for the first time in thirteen years. Belviq was approved in July for obese adults with high blood pressure, Osymia, approved for the patient group, got the FDA’s nod a month later.

Read NewPublicHealth News Roundups.

IOM Committee to Explore Sports-related Concussions
Youth sports concussions will be a focus of an Institute of Medicine Committee next year. The committee will conduct a study on youth, from elementary school through young adulthood, including military personnel and their dependents. The committee will also review concussion risk factors; screening and diagnosis; treatment and management; and long-term consequences. Read more on injury prevention.

Scheduling Cardiac Rehab Soon After a Heart Attack Improves Compliance
A new study in Circulation found that scheduling cardiac rehabilitation to begin sooner rather than later following a heart attack increased the chance that patients show up for the first and subsequent sessions. Cardiac rehab, which includes supervised exercise and nutrition counseling, has been linked to a reduction in second heart attacks in patients who complete the multi-week programs. In the new study, patients whose first rehab session was scheduled within ten days of hospital discharge were more likely to come to the first session than were patients whose appointments were scheduled for within 35 days of discharge, which is a standard time frame in the United States. Read more on heart health.

Young Adult Smoking Rates Fell in 2012
A recent survey from the National Institute on Drug Abuse finds that youth smoking rates fell in 2012 among eighth, tenth and twelfth graders. This is the second year in a row that the survey found a significant annual decline in youth smoking, following several years during which progress on getting more young people to quit had stalled.

According to the Campaign for Tobacco Free Kids, strategies that led to the lower smoking levels include higher tobacco taxes, well-funded tobacco prevention and cessation programs that include mass media campaigns, strong smoke-free laws, and effective regulation of tobacco products and marketing.

Read more on tobacco

Rural Residents Less Likely to Follow Colon Cancer Screening Guidelines
A new study from the University of Utah finds that people who live in rural communities are less likely to follow colorectal cancer screening recommendations than urban residents. The researchers say the geographic disparity is evident across all risk groups, including those who have a family history of the disease. The study was published in the journal Clinical Gastroenterology and Hepatology.

The researchers looked at data from the Behavior Risk Factor Surveillance System, a set of telephone surveys coordinated by the Centers for Disease Control and state health departments. Factors that impact screening, according to the researchers include distance to screening facilities, fewer rural residents are covered by health insurance for colorectal screening (the researchers note that this is likely to be improved under the Affordable Care Act) and rural residents are less likely to receive a recommendation for screening from a health care provider because there are fewer primary care providers in rural areas, and those providers are under time constraints.

Read more on prevention 

Workplace Injury, Illness Often Taxes Financial Stability of Low Wage Workers

A new policy brief from the George Washington University school of Public Health and Health Services in Washington, DC finds that low wage workers are especially vulnerable to financial troubles that can result from on-the-job injuries and illnesses.

The researchers calculated that in 2010 1.6 million low wage earners suffered from non-fatal injuries, and 87,857 developed non-fatal occupational health problems such as asthma and found that workers compensation insurance either does not apply or fails to cover many expenses, which can bankrupt families with no financial cushion. According to the brief, insurers cover less than one-fourth of the costs of occupational injuries and illnesses. The rest falls on workers’ families, non-workers-compensation health insurers, and taxpayer-funded programs like Medicaid. The researchers say policy makers need to improve workplace safety and strengthen the safety net for low wage workers.

Read more on injury prevention